Treatment Of Parathyroid Disease Research Articles

Endoscopic assisted parathyroid surgery via a subclavian approach

Objective:To explore the safety and efficacy of airless endoscopic surgery in the treatment of parathyroid diseases. Methods:By retrospective comparison, clinical treatment of 26 patients with primary hyperparathyroidism admitted to the Department of Otolaryngology and Head and Neck Surgery of the Hospital, Sun Yat-sen University from January 2018 to January 2023 were collected. They were divided into traditional group（13 cases） and endoscopic group（13 cases） according to the surgical method. The traditional group underwent traditional open parathyroid surgery, and the endoscopic group underwent airless endoscopic surgery through the subclavian approach. The efficacy, postoperative incision pain, incidence of adverse events, and aesthetic effects of the two groups were evaluated. Results:A total of 26 patients were included, including 13 patients in the traditional group and 13 patients in the endoscopic group. There was no significant difference in the incidence of hypocalcemia and transient hypoparathyroidism on the first day after surgery between the two groups（P>0.05）. No patients with incision pain（>3 points） or swallowing pain were found in both groups after the operation, and they were afraid or unwilling to cough and expel phlegm. There were no significant differences in the amount of blood loss, duration of operation, incidence of temporary recurrent laryngeal nerve palsy and transient hypocalcemia, and postoperative pain score between the two groups. The endoscopic group's scar evaluation score and aesthetic effect satisfaction score at 6 months after surgery were higher than those of the traditional group（P<0.01）. Conclusion:Airless Endoscopic parathyroid surgery via the subclavian approach has good effectiveness and safety, which did not significantly increase the risk of surgery. It can safely remove the lesion and leave no surgical scar on the anterior neck, which has the advantage of a good cosmetic effect. It is a safe and feasible endoscopic parathyroid surgery and can be used as a new choice for patients undergoing parathyroid surgery.

Parathyroid ultrasonography: the evolving role of the radiologist.

Previously, radiologists played a limited role in the treatment of parathyroid disease, primary focusing on the preoperative localization of parathyroid lesions responsible for hyperparathyroidism. But, the widespread use of high-resolution ultrasound has lead to the increasing detection of parathyroid incidentalomas (PTIs). Consequently, radiologists may be required to differentiate PTIs from thyroid lesions, which is most reliably accomplished through the fine needle aspiration-parathyroid hormone analysis. Various nonsurgical treatment modalities for hyperfunctioning parathyroid lesions have been developed with some efficacy. Especially for symptomatic nonfunctioning parathyroid cysts, simple aspiration is a first-line procedure for diagnosis and treatment, while ethanol ablation is a subsequent treatment modality for recurrent cases.

Parathyroid Adenomas Seen in the Clinical Follow-Up of Patients With Differentiated Thyroid Carcinoma

The coexistence of nonmedullary thyroid carcinoma and parathyroid adenoma is an uncommon clinical entity. In most of the previously published studies, thyroid carcinomas are diagnosed incidentally during or after the treatment of parathyroid disease, mostly in the pathology specimens. Here, we report 2 cases of parathyroid adenoma who presented years after the treatment of differentiated thyroid carcinoma. Neither of the patients had symptoms of hypercalcemia and hyperparathyroidism, and parathyroid adenomas were diagnosed on routine physical examination of the neck and on routine monitoring of serum calcium levels.

Article Commentary: Current Applications of the Intraoperative Parathyroid Hormone Assay in Parathyroid Surgery

Parathyroid hormone measurement using a two-site immunochemiluminometric assay has allowed for a rapid and accurate technique that has found its way into the operative armamentarium of some parathyroid surgeons. It can be used to assess the completeness of parathyroid gland resection and allow for a minimally invasive parathyroidectomy. This operative approach has become a popular marketing tool, providing patients with confidence in their surgical outcome. The purpose of this review is to provide the surgeon with the practical points and pitfalls of the use of intraoperative parathyroid hormone in the treatment of parathyroid disease.

Parathyroidectomy at Ito Hospital: a review of a thyroid clinic in Japan

We primarily describe surgical methods and short-stay surgery, which has been recently attracting interest in Japan, in relation to the diagnosis and treatment of parathyroid disease at a special hospital for thyroid diseases. There is a controversy in regard to surgical methods for primary hyperparathyroidism (PHPT), whether it is sufficient to examine only one side or all four glands should be checked. At our hospital, we selected one of the following three different approaches depending on the case: where the lesion was excised after checking all four glands on both sides (Method A), where the lesion was excised after checking two glands by examining one side (Method B), and where the lesion of one gland was directly excised (Method C). A review of the initial operations for 185 cases of PHPT treated at our hospital over 18 years revealed that the patients who underwent Methods B and C under local anesthesia had developed no complications and their long-term postoperative outcome was also favorable. In the future we also intend to adopt the unilateral approach aggressively under local anesthesia and perform short-stay surgery in cases which pathological parathyroid glands have been discovered by preoperative localization.

Surgical treatment of parathyroid disease: a review.

Since the first parathyroidectomy was performed by Mandl in 1925, there have been many advances in our understanding of the parathyroid gland and its related disorders of calcium homeostasis. Our ability to establish the diagnosis of parathyroid neoplasia and locate the source of autonomous parathormone production has also dramatically improved. Nevertheless, it was the advent of the routine calcium and phosphate screening done on the sequential multiple analyzer (SMA-12) that has caused a tremendous increase in the number of patients who are diagnosed to have hyperparathyroidism and who therefore present for surgical treatment. Essential for successful and uncomplicated treatment of this disorder is a thorough understanding of the anatomy, physiology, and pathology of the parathyroid glands. This review will consider the parathyroid glands in their normal state, as well as the diagnosis and management of the various disorders associated with them.